Research led by Imperial College London has found that 36% of UK doctors may suffer from workplace burnout, rising to 43% of trainee doctors, reports Medical Xpress. Burnout is a condition triggered by long-term stress and overload at work, and in particular is associated with emotional exhaustion, lack of empathy and connection with others, and feeling a lack of personal accomplishment. Although burnout can affect individuals in any career, it particularly affects those in those in high-stress jobs – with previous studies suggesting that doctors are twice as likely to suffer burnout compared to those in other professions.
The study, a collaboration between Imperial College London, KU Leuven in Belgium and the Royal College of Obstetricians and Gynaecologists, also revealed that 43% of trainee doctors met the criteria for burnout.
The research, which is the largest UK study on this topic, used a well-accepted tool, called the Maslach Burnout Inventory, to measure burnout on over 3,000 doctors. In addition, the research asked doctors specific questions about their physical and mental wellbeing, as well as how they practice medicine- focusing particularly on so-called defensive medicine.
The research was carried out on doctors in the field of obstetrics and gynaecology – these specialists are responsible for treating women who are pregnant, delivering babies, as well as treating conditions such as ovarian and cervical cancer.
The study found 36% of doctors met the criteria for burnout. The doctors who met the criteria for burnout were six times more likely to experience suicidal thoughts, four times more likely to report depression, and three times more likely to report anxiety, irritability and anger. They also suffered from sleep and relationship problems.
The work also revealed that doctors with burnout were four times more likely to practice “defensively” – meaning a doctor may avoid difficult cases or procedures, over prescribe medications, or carry out more investigations or treatments than necessary, for fear of making a mistake or missing a diagnosis.
Previous studies have also linked burnout to lower standards of patient care and reduced patient safety explained Professor Tom Bourne, lead author of the research from the department of metabolism, digestion and reproduction at Imperial: “We found the results of this survey very worrying. The levels of burnout were high, particularly amongst younger doctors. This has serious implications for patients, as we know burnout reduces patient satisfaction, safety and standards of care.
“These results point to an environment in UK hospitals that makes staff unwell and less able to carry out their jobs safely. There is a clear need to address both the workplace and culture.”
The research team caution that people who are suffering from burnout may have been more likely to respond to the survey, which may have affected the result—but equally people experiencing symptoms may have been less inclined to answer questions on the subject.
Bourne explained there has been little research investigating levels of burnout in other medical specialities in the UK. However, US studies show it is prevalent in staff across all areas of medicine, and this situation is likely to be mirrored in the UK. He explained these current findings add to increasing evidence that suggests the NHS needs to urgently investigate strategies for preventing burnout: “Improving our understanding of doctor burnout must become a priority. Reducing burnout will improve doctors’ wellbeing with resultant improvements in staff retention, productivity and patient safety. The report adds critical evidence to the recent review into doctors’ wellbeing published by the General Medical Council in the UK.”
Bourne, a consultant gynaecologist, added: “The solutions lie in improving the environment doctors work in, and relate to reducing workload, rebuilding supportive teams, compassionate leadership, improving the values and culture of hospitals, and giving doctors more autonomy and fairness”.
Dr Alison Wright, vice president of the Royal College of Obstetricians and Gynaecologists, said: “The potential impact of workforce burnout is crucial to our national health service and to patient care. This important study provides compelling evidence that there is an urgent need to improve the workplace environment for doctors. We know burnout is associated with worse outcomes for patients, as well as a lack of empathy and rapport. It is vital the issue of burnout is addressed, so we can sustainably deliver the very best care for our patients.
“A key priority for the RCOG is to ensure the obstetrics and gynaecology workforce is properly supported. We have established a ‘Supporting our Doctors’ task Group, which includes a ‘peer to peer’ support service and a network of workforce champions to provide pastoral and practical support to doctors and employers.
“This task group advocates for the changes that need to be made to minimise burnout and attrition. These include all clinicians having acceptable working patterns, for their workload to be controlled, for adequate peer and senior support within teams and for leadership in hospitals to be more compassionate. This will require a real change in culture.
“The RCOG is collaborating with other Colleges, the GMC and government organisations, to understand and address the systemic issues which are associated with burnout so we can, both improve the wellbeing of doctors and the care we provide for women and their families.”
Objectives: To determine the prevalence of burnout in doctors practising obstetrics and gynaecology, and assess the association with defensive medical practice and self-reported well-being.
Design: Nationwide online cross-sectional survey study; December 2017–March 2018.
Setting: Hospitals in the UK.
Participants: 5661 practising obstetrics and gynaecology consultants, specialty and associate specialist doctors and trainees registered with the Royal College of Obstetricians and Gynaecologists.
Primary and secondary outcome measures: Prevalence of burnout using the Maslach Burnout Inventory and defensive medical practice (avoiding cases or procedures, overprescribing, over-referral) using a 12-item questionnaire. The odds ratios (OR) of burnout with defensive medical practice and self-reported well-being.
Results: 3102/5661 doctors (55%) completed the survey. 3073/3102 (99%) met the inclusion criteria (1462 consultants, 1357 trainees and 254 specialty and associate specialist doctors). 1116/3073 (36%) doctors met the burnout criteria, with levels highest amongst trainees (580/1357 (43%)). 258/1116 (23%) doctors with burnout reported increased defensive practice compared with 142/1957 (7%) without (adjusted OR 4.35, 95% CI 3.46 to 5.49). ORs of burnout with well-being items varied between 1.38 and 6.37, and were highest for anxiety (3.59, 95% CI 3.07 to 4.21), depression (4.05, 95% CI 3.26 to 5.04) and suicidal thoughts (6.37, 95% CI 95% CI 3.95 to 10.7). In multivariable logistic regression, being of younger age, white or ‘other’ ethnicity, and graduating with a medical degree from the UK or Ireland had the strongest associations with burnout.
Conclusions: High levels of burnout were observed in obstetricians and gynaecologists and particularly among trainees. Burnout was associated with both increased defensive medical practice and worse doctor well-being. These findings have implications for the well-being and retention of doctors as well as the quality of patient care, and may help to inform the content of future interventions aimed at preventing burnout and improving patient safety.
Tom Bourne, Harsha Shah, Nora Falconieri, Dirk Timmerman, Christoph Lees, Alison Wright, Mary Ann Lumsden, Lesley Regan, Ben Van Calster